Effects of gender-affirming hormone therapy from adolescence to adulthood on cardiovascular function: a cross-sectional study

Aim: Increased cardiovascular risk in transgender adults might be linked in part to metabolic changes associated with gender-affirming hormone therapy (GAHT) and lifestyle factors. However, the cardiovascular effects of long-term GAHT, particularly when initiated during adolescence, remain poorly understood. Methods: Echocardiographic evaluations were performed in 47 trans men (TM) and 6 trans women (TW) who had undergone GAHT for 5-10 years. Assessments included systolic and diastolic function, ventricular and aortic diameters, and aortic elasticity parameters. Cardiovascular risk factors (e.g., hypertension, obesity, impaired glucose tolerance, dyslipidemia, smoking, and alcohol use) were also analyzed. Results: Median (IQR) GAHT duration was 6.0 (2.8) years in TM and 7.8 (2.6) years in TW; median ages were 23.4 (2.2) and 25.3 (2.7) years, respectively. Most of the cardiovascular parameters were within normal range, as all participants showed normal systolic function, and only one TM exhibited grade 2 diastolic dysfunction. Additionally, left ventricle (LV) diameters, LV mass indexed for BSA and aortic diameters were also within normal reference ranges in both groups. Nevertheless, GAHT was associated with significant reduction of aortic distensibility and strain in comparison to normal reference values, while increasing aortic stiffness index in both TM and TW. In TM, reduced aortic distensibility was independently associated with increases in systolic blood pressure. Conclusions: Long-term GAHT initiated during adolescence in both TW and TM shows no apparent cardiac complications with regard to cardiac function, hypertrophy, or chamber dimensions, and does not significantly affect aortic diameters. However, alterations in aortic elasticity were observed, the long-term clinical significance of which remains to be determined.